Mandatory and Must Support Data Elements

The following data elements must always be present (in other words, mandatory resource properties where the minimum cardinality is 1) or must be supported (Must Support definition). Servers cannot restrict access to mandatory elements when authorizing an application. However, servers may choose to provide additional information or may be required to do so by national or other profiles that apply to the server’s context.

This specification is currently published as a Standard for Trial Use (STU). Feedback is welcome and may be submitted through the FHIR change tracker indicating "International Patient Access (FHIR)" as the specification. The publishers of the specification are seeking feedback on two elements in this Patient profile.

1. Currently, the Patient.identifier element is identified as mandatory. The intent is that all servers must provide a unique patient identifier that can facilitate a federated approach to accessing patient information. Please provide any evidence for or against this decision.
2. In the balloted version of this specification, the Patient.name element was identified as mandatory (meaning minimal cardinality of 1) and provided a rule that the use of the Data Absent Reason (DAR) extension was allowed. In this published version, Patient.name is not mandatory. It was expressed that having the minimal cardinality of 1 may not enable privacy preserving mechanisms, such as patients limiting client application access to their demographic information, including name, as part of the authorization process. Implementer feedback is requested on whether Patient.name should be a mandatory element.

Each Patient SHALL have:

• a patient identifier (e.g. MRN)

Applications must also support:

• a patient name
• an administrative gender (note: this is for administrative purposes; see note about Patient Gender and Sex for discussion)
• an active flag (It SHALL be present if patients links are present)*
• Birth date
• Patient Link*

* See guidance below

Profile Specific Implementation Rules and Guidance

During the Authorization process, the user and the Authorization service fixes the patient record to a single individual patient. For safety, client applications should specify the patient id when searching other resources.

The client application SHALL be capable of accessing the patient record using the following API call:

GET [url]/Patient/[id]

The client application MAY use these search parameters that servers are required to support to access the patient record:

• _id
• identifier

Servers are not required to support any additional search parameters, and clients SHOULD NOT expect servers to do so.

Additional rules and guidance for supporting Patient.link:

• The server:
  • SHALL have no more than one Patient with a status of active = “true” from the server being queried
  • MAY include inactive patients on the same server
  • MAY include inactive or active patients from a different server
  • When returning a search Bundle that contains more than one Patient record for the same patient, the Patient record(s) SHALL use the Patient.link attribute to cross-link the Patient resources.
• The client:
  • SHALL be able to follow the link(s) to the other Patient resource(s) and understand the direction of the link (in other words, which Patient is linked to which other Patient)
  • SHALL understand the Patient.link.type code which defines the type of link between this Patient resource and another Patient resource
  • SHALL be aware of the linked Patient active flag and that inactive patients may have relevant information

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Patient

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
identifier	SC	1..*	Identifier	An identifier for this patient ipa-pat-1: At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present
value	S	1..1	string	The value that is unique within the system.
active	SC	0..1	boolean	Whether this patient's record is in active use ipa-pat-4: If Patient.link is present, then Patient.active SHALL be present
name	SC	0..*	HumanName	A name associated with the patient ipa-pat-2: Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. ipa-pat-3: To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present.
gender	S	0..1	code	male | female | other | unknown
birthDate	S	0..1	date	The date of birth for the individual
link	SC	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
ipa-pat-1	error	Patient.identifier	At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present : system.exists() or type.exists() or assigner.exists()
ipa-pat-2	error	Patient.name	Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. : (family.exists() or given.exists() or text.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()
ipa-pat-3	best practice	Patient.name	To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present. : text.exists()
ipa-pat-4	error	Patient.active	If Patient.link is present, then Patient.active SHALL be present : link.exists() implies active.exists()

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣC	1..*	Identifier	An identifier for this patient ipa-pat-1: At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
active	?!SΣC	0..1	boolean	Whether this patient's record is in active use ipa-pat-4: If Patient.link is present, then Patient.active SHALL be present
name	SΣC	0..*	HumanName	A name associated with the patient ipa-pat-2: Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. ipa-pat-3: To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present.
gender	SΣ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate	SΣ	0..1	date	The date of birth for the individual
deceased[x]	?!Σ	0..1		Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
link	?!SΣC	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Patient.identifier.use	required	IdentifierUse
Patient.gender	required	AdministrativeGender
Patient.link.type	required	LinkType

Constraints

Id	Grade	Path(s)	Details	Requirements
ipa-pat-1	error	Patient.identifier	At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present : system.exists() or type.exists() or assigner.exists()
ipa-pat-2	error	Patient.name	Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. : (family.exists() or given.exists() or text.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()
ipa-pat-3	best practice	Patient.name	To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present. : text.exists()
ipa-pat-4	error	Patient.active	If Patient.link is present, then Patient.active SHALL be present : link.exists() implies active.exists()

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣC	1..*	Identifier	An identifier for this patient ipa-pat-1: At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	?!SΣC	0..1	boolean	Whether this patient's record is in active use ipa-pat-4: If Patient.link is present, then Patient.active SHALL be present
name	SΣC	0..*	HumanName	A name associated with the patient ipa-pat-2: Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. ipa-pat-3: To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present.
telecom	Σ	0..*	ContactPoint	A contact detail for the individual
gender	SΣ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate	SΣ	0..1	date	The date of birth for the individual
deceased[x]	?!Σ	0..1		Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	Σ	0..*	Address	An address for the individual
maritalStatus		0..1	CodeableConcept	Marital (civil) status of a patient Binding: Marital Status Codes (extensible): The domestic partnership status of a person.
multipleBirth[x]		0..1		Whether patient is part of a multiple birth
multipleBirthBoolean			boolean
multipleBirthInteger			integer
photo		0..*	Attachment	Image of the patient
contact	C	0..*	BackboneElement	A contact party (e.g. guardian, partner, friend) for the patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
relationship		0..*	CodeableConcept	The kind of relationship Binding: PatientContactRelationship (extensible): The nature of the relationship between a patient and a contact person for that patient.
name		0..1	HumanName	A name associated with the contact person
telecom		0..*	ContactPoint	A contact detail for the person
address		0..1	Address	Address for the contact person
gender		0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
organization	C	0..1	Reference(Organization)	Organization that is associated with the contact
period		0..1	Period	The period during which this contact person or organization is valid to be contacted relating to this patient
communication		0..*	BackboneElement	A language which may be used to communicate with the patient about his or her health
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language		1..1	CodeableConcept	The language which can be used to communicate with the patient about his or her health Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
preferred		0..1	boolean	Language preference indicator
generalPractitioner		0..*	Reference(Organization | Practitioner | PractitionerRole)	Patient's nominated primary care provider
managingOrganization	Σ	0..1	Reference(Organization)	Organization that is the custodian of the patient record
link	?!SΣC	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Patient.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Patient.identifier.use	required	IdentifierUse
Patient.identifier.type	extensible	Identifier Type Codes
Patient.gender	required	AdministrativeGender
Patient.maritalStatus	extensible	Marital Status Codes
Patient.contact.relationship	extensible	PatientContactRelationship
Patient.contact.gender	required	AdministrativeGender
Patient.communication.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Patient.link.type	required	LinkType

Constraints

Id	Grade	Path(s)	Details	Requirements
ipa-pat-1	error	Patient.identifier	At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present : system.exists() or type.exists() or assigner.exists()
ipa-pat-2	error	Patient.name	Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. : (family.exists() or given.exists() or text.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()
ipa-pat-3	best practice	Patient.name	To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present. : text.exists()
ipa-pat-4	error	Patient.active	If Patient.link is present, then Patient.active SHALL be present : link.exists() implies active.exists()

Differential View

This structure is derived from Patient

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
identifier	SC	1..*	Identifier	An identifier for this patient ipa-pat-1: At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present
value	S	1..1	string	The value that is unique within the system.
active	SC	0..1	boolean	Whether this patient's record is in active use ipa-pat-4: If Patient.link is present, then Patient.active SHALL be present
name	SC	0..*	HumanName	A name associated with the patient ipa-pat-2: Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. ipa-pat-3: To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present.
gender	S	0..1	code	male | female | other | unknown
birthDate	S	0..1	date	The date of birth for the individual
link	SC	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
ipa-pat-1	error	Patient.identifier	At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present : system.exists() or type.exists() or assigner.exists()
ipa-pat-2	error	Patient.name	Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. : (family.exists() or given.exists() or text.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()
ipa-pat-3	best practice	Patient.name	To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present. : text.exists()
ipa-pat-4	error	Patient.active	If Patient.link is present, then Patient.active SHALL be present : link.exists() implies active.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣC	1..*	Identifier	An identifier for this patient ipa-pat-1: At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
active	?!SΣC	0..1	boolean	Whether this patient's record is in active use ipa-pat-4: If Patient.link is present, then Patient.active SHALL be present
name	SΣC	0..*	HumanName	A name associated with the patient ipa-pat-2: Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. ipa-pat-3: To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present.
gender	SΣ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate	SΣ	0..1	date	The date of birth for the individual
deceased[x]	?!Σ	0..1		Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
link	?!SΣC	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Patient.identifier.use	required	IdentifierUse
Patient.gender	required	AdministrativeGender
Patient.link.type	required	LinkType

Constraints

Id	Grade	Path(s)	Details	Requirements
ipa-pat-1	error	Patient.identifier	At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present : system.exists() or type.exists() or assigner.exists()
ipa-pat-2	error	Patient.name	Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. : (family.exists() or given.exists() or text.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()
ipa-pat-3	best practice	Patient.name	To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present. : text.exists()
ipa-pat-4	error	Patient.active	If Patient.link is present, then Patient.active SHALL be present : link.exists() implies active.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣC	1..*	Identifier	An identifier for this patient ipa-pat-1: At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	?!SΣC	0..1	boolean	Whether this patient's record is in active use ipa-pat-4: If Patient.link is present, then Patient.active SHALL be present
name	SΣC	0..*	HumanName	A name associated with the patient ipa-pat-2: Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. ipa-pat-3: To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present.
telecom	Σ	0..*	ContactPoint	A contact detail for the individual
gender	SΣ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate	SΣ	0..1	date	The date of birth for the individual
deceased[x]	?!Σ	0..1		Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	Σ	0..*	Address	An address for the individual
maritalStatus		0..1	CodeableConcept	Marital (civil) status of a patient Binding: Marital Status Codes (extensible): The domestic partnership status of a person.
multipleBirth[x]		0..1		Whether patient is part of a multiple birth
multipleBirthBoolean			boolean
multipleBirthInteger			integer
photo		0..*	Attachment	Image of the patient
contact	C	0..*	BackboneElement	A contact party (e.g. guardian, partner, friend) for the patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
relationship		0..*	CodeableConcept	The kind of relationship Binding: PatientContactRelationship (extensible): The nature of the relationship between a patient and a contact person for that patient.
name		0..1	HumanName	A name associated with the contact person
telecom		0..*	ContactPoint	A contact detail for the person
address		0..1	Address	Address for the contact person
gender		0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
organization	C	0..1	Reference(Organization)	Organization that is associated with the contact
period		0..1	Period	The period during which this contact person or organization is valid to be contacted relating to this patient
communication		0..*	BackboneElement	A language which may be used to communicate with the patient about his or her health
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language		1..1	CodeableConcept	The language which can be used to communicate with the patient about his or her health Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
preferred		0..1	boolean	Language preference indicator
generalPractitioner		0..*	Reference(Organization | Practitioner | PractitionerRole)	Patient's nominated primary care provider
managingOrganization	Σ	0..1	Reference(Organization)	Organization that is the custodian of the patient record
link	?!SΣC	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Patient.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Patient.identifier.use	required	IdentifierUse
Patient.identifier.type	extensible	Identifier Type Codes
Patient.gender	required	AdministrativeGender
Patient.maritalStatus	extensible	Marital Status Codes
Patient.contact.relationship	extensible	PatientContactRelationship
Patient.contact.gender	required	AdministrativeGender
Patient.communication.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Patient.link.type	required	LinkType

Constraints

Id	Grade	Path(s)	Details	Requirements
ipa-pat-1	error	Patient.identifier	At least one of Patient.identifier.system or Patient.identifier.type or Patient.identifier.assigner SHALL be present : system.exists() or type.exists() or assigner.exists()
ipa-pat-2	error	Patient.name	Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present or a Data Absent Reason Extension SHALL be present. : (family.exists() or given.exists() or text.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()
ipa-pat-3	best practice	Patient.name	To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present. : text.exists()
ipa-pat-4	error	Patient.active	If Patient.link is present, then Patient.active SHALL be present : link.exists() implies active.exists()

This structure is derived from Patient

Summary

Mandatory: 2 elements
Must-Support: 7 elements